A New Nasal Restriction Device Called FeelBreathe(R)Improves Breathing Patterns in Chronic Obstructive Pulmonary Disease Patients during Exercise

A device called FeelBreathe (FB)(R)was designed, developed, and patented for inspiratory muscle training. The main aim was to determine the acute responses on lung ventilation, gas exchange, and heart rate during exercise in patients with chronic obstructive pulmonary disease (COPD) with and without the use of FB. In this study, a randomized cross-over trial was performed with 18 men diagnosed with COPD (FEV(1)between 30% and 70% of its predicted value). Each participant randomly conducted two trials with 30 min of rest between them with the same protocol on a treadmill for 10 min at a constant rate of 50% of VO2peak. Each test was performed randomly and in a crossover randomized design in two different conditions: (1) oronasal breathing; and (2) nasal breathing with FB (nasal ventilatory flow restriction device). It was observed that FB had positive effects on dynamic hyperinflation, breathing pattern, and breathing efficiency, with higher expiratory and inspiratory time. Despite these differences, blood oxygen saturation percentage, oxygen uptake, and heart rate showed a similar response for both conditions during exercise. The results suggest that exercise performed with FB improved ventilatory responses compared to the oronasal mode in COPD patients. This new tool could be used during most daily tasks and exercise programs

Key Pulmonology and Thoracic Surgery Issues under Discussion in the COVID-19 Era

Para finalizar un año tan complejo como el 2020 a causa de la pandemia por SARS-CoV-2 (COVID-19), tuvimos la oportunidad de celebrar, bajo el amparo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la segunda edición del Foro de presidentes de las sociedades científicas autonómicas de neumología y cirugía torácica de España. Esta pandemia ha puesto en una situación crítica a los sistemas de salud de las diferentes comunidades autónomas españolas, cada uno de ellos con sus peculiaridades y modelos de gestión diferentes. Y en concreto, debido a la afinidad de la COVID-19 por el aparato respiratorio, los servicios de Neumología se han visto directamente involucrados, obligados a modificar sus estructuras y distribución de recursos en tiempo récord para poder proporcionar la mejor asistencia sanitaria posible a estos enfermos. Todo ello, ante una situación de enorme complejidad, no solo por el incremento en la carga asistencial que ha supuesto, sino también por la gran incertidumbre asociada en las fases más iniciales de la pandemia. El desconocimiento de la propia enfermedad y la limitación de recursos disponibles complicó aún más la gestión y la atención sanitaria en una situación sumamente difícil. Estas vivencias relacionadas con la pandemia han marcado esta nueva edición del Foro de presidentes autonómicos y nos ha permitido conocer diferentes puntos de vista y modelos de respuesta según los distintos sistemas de salud implicados, como ya ocurriera en la edición anterior1. No obstante, la vida continúa a pesar de los cambios provocados por el SARS-CoV-2. Por lo tanto, manteniendo el carácter inclusivo e innovador que dio lugar a la creación de este foro a través de la SEPAR, en esta nueva edición se abordaron 5 mesas de debate con temas de especial relevancia para el desarrollo de la Neumología y la Cirugía Torácica en España, cuyas conclusiones se resumen a continuación

Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone

BACKGROUND: The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate. METHODS: In this multicenter, randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of life-threatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization). Noninferiority of fluticasone-salmeterol to fluticasone alone was defined as an upper boundary of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The efficacy end point was the first severe asthma exacerbation. RESULTS: Of 11,679 patients who were enrolled, 67 had 74 serious asthma-related events, with 36 events in 34 patients in the fluticasone-salmeterol group and 38 events in 33 patients in the fluticasone-only group. The hazard ratio for a serious asthma-related event in the fluticasone-salmeterol group was 1.03 (95% confidence interval [CI], 0.64 to 1.66), and noninferiority was achieved (P=0.003). There were no asthma-related deaths; 2 patients in the fluticasone-only group underwent asthma-related intubation. The risk of a severe asthma exacerbation was 21% lower in the fluticasone-salmeterol group than in the fluticasone-only group (hazard ratio, 0.79; 95% CI, 0.70 to 0.89), with at least one severe asthma exacerbation occurring in 480 of 5834 patients (8%) in the fluticasone-salmeterol group, as compared with 597 of 5845 patients (10%) in the fluticasone-only group (P<0.001). CONCLUSIONS: Patients who received salmeterol in a fixed-dose combination with fluticasone did not have a significantly higher risk of serious asthma-related events than did those who received fluticasone alone. Patients receiving fluticasone-salmeterol had fewer severe asthma exacerbations than did those in the fluticasone-only group